| NPI | 1063803062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024225) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2019-05-07 |